Re: Chemotherapy in early breast cancer


"Steph" <steph@xxxxxxxxxxxxxxxxx> wrote in message
news:myske.1459400$6l.605199@xxxxxxxxxxx
>
> "Peter Moran" <moringa@xxxxxxxxxx> wrote in message
> news:42924571$0$262$61c65585@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>>I confess to having had the suspicion that adjuvant chemotherapy was being
>>used too readily
>> in early breast cancer in some quarters, especially in the US. I was
>> wrong.
>>
>
> I'm not sure you were wrong Peter
>
> The prognosis for early stage breast cancer is VERY good, chemo or not.
> The 38% reduction in death rate is maybe 3% in absolute terms.

I take your point. Quoting the paper--

"With 74 000 years of follow-up among untreated women with breast cancer of
known ER and nodal status in these trials (36 000 in ER-positive
node-negative, 16 000 in ER-positive node-positive, 17 000 in ER-poor
node-negative, and 5000 in ER-poor node-positive disease), the breast cancer
mortality at 5, 10, and 15 years, respectively, is 7%, 20%, and 31% in
ER-positive node-negative disease, and 23%, 51%, and 63% in ER-positive
node-positive disease. Among untreated women of the same nodal status, the
breast cancer death rate is about twice as great in ER-poor as in
ER-positive disease during just the first 5 or 6 years, but it is
substantially lower in ER-poor than in ER-positive disease over the next 10
years, so the 15-year breast cancer mortality of untreated women is largely
independent of ER status (and of age; webappendix 1"

So the absolute reduction in mortality is 38/100 X 31 equals a 12% gain in
fifteen year survival (twelve lives saved per hundred) even in
node-negative disease, and regardless of ER status, and with six months only
of chemotherapy. This is better than I expected and would represent many
thousands of lives saved out of the two hundred thousand plus cases of BC
yearly in the US alone..

You are right that this is merely a snapshot of how we stood over fifteen
years ago. Better ways classifying cancer into prognostic categories are
now available. The urgent need is to be able to select out those women who
have such negligible chances of dying from their breast cancer as to not
justify chemotherapy, and deciding where that line should be drawn. Minimal
morbidity has been shown from the chemotherapy in the same studies..

Peter Moran


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